Geneviève Petit

Benefits and costs of immunization of children with pneumococcal conjugate vaccine in Canada

To estimate cost-effectiveness of routine and catch-up vaccination of Canadian children with seven-valent pneumococcal conjugate vaccine, a simulation model was constructed. In base scenario (vaccination coverage: 80%, and vaccine price: 58 dollars per dose), pneumococcal disease incidence reduction would be superior to 60% for invasive infections, and to 30% for non-invasive infections, but the number of deaths prevented would be small. Annual costs of routine immunization would be 71 million dollars (98% borne by the health system). Societal benefit to cost ratio would be 0.57. Net societal costs per averted pneumococcal disease would be 389 dollars and 125,000 per life-year gained (LYG). Vaccine purchase cost is the most important variable in sensitivity analyses, and program costs would be superior to societal benefits in all likely scenarios. Vaccination would result in net savings for society, if vaccine cost is less than 30 dollars per dose. Economic indicators of catch-up programs are less favorable than for routine infant immunization.

Predictors of crack cocaine initiation among Montréal street youth: A first look at the phenomenon

BACKGROUND Crack cocaine use is increasing in Montréal. However, initiation risk factors among street youth are unknown. The goal of this project is to estimate the incidence of first crack cocaine use among these youth and to identify the associated risk factors. METHODS A prospective cohort study of HIV and hepatitis C incidence was conducted among street youth from 2001 to 2005. A questionnaire on sexual and drug use behaviours was administered every 6 months. Incidence was estimated (a) for youth who had never used crack cocaine at recruitment (n=203) and, among them, (b) for those who had snorted cocaine before (n=122). The risk factors for initiation of crack use as well for initiation into a new route of cocaine administration among youth who had snorted cocaine before were determined using Cox regression. RESULTS Incidence rates for crack cocaine use were (a) 136.6/1000 person-years (p-y) (95% confidence interval [CI]: 104.5-175.5) and (b) 205.8/1000 p-y (95% CI: 150.2-275.3). The number of substance types used recently increased the risk of initiating crack use (adjusted hazard ratio [AHR]=1.84 per substance type, 95% CI: 1.55-2.18), whereas having a parent with a substance abuse problem decreased that risk (AHR=0.48, 95% CI: 0.26-0.89). The risk factors were identical among youth who had snorted cocaine before. CONCLUSIONS Our analyses show a high incidence of crack use among street youth. It is important to delve more deeply into the phenomenon of initiation if we wish to develop effective prevention measures for these young people.

Cost-effectiveness of a 3-dose pneumococcal conjugate vaccine program in the province of Quebec, Canada

In the province of Quebec, Canada, the pneumococcal 7-valent conjugate vaccine (PCV-7) was licensed in 2001 and a publicly funded program was implemented in 2004, recommending 3 doses for healthy children. An economic analysis was performed both from a health care and societal perspective. Outcomes possibly prevented by PCV-7 and observed in 2006-2007 were compared to expected frequencies based on rates measured before PCV-7 use. Annual program costs were close to

Effectiveness of rotavirus vaccine in preventing severe gastroenteritis in young children according to socioeconomic status

21M for the health system and

The public health response during and after the Lac-Mégantic train derailment tragedy: a case study

23M for society. Approximately 20,000 infections were prevented annually and estimated economic benefits were

A postpartum vaccination promotion intervention using motivational interviewing techniques improves short-term vaccine coverage: PromoVac study

5M for the health system and

Trends in severe gastroenteritis among young children according to socio-economic characteristics before and after implementation of a rotavirus vaccination program in Quebec

23M for society, using a 3% per annum discounting rate. The incremental cost-effectiveness ratio was

Determinants of influenza vaccination among a large adult population in Quebec

18,000 per QALY gained for the health system and the program was close to the break-even threshold in a societal perspective.

Overview of knowledge, attitudes, beliefs, vaccine hesitancy and vaccine acceptance among mothers of infants in Quebec, Canada

ABSTRACT In 2011, the monovalent rotavirus vaccine was introduced into a universal immunization program in Quebec (Canada). This retrospective cohort study assessed vaccine effectiveness (VE) in preventing acute gastroenteritis (AGE) and rotavirus gastroenteritis (RVGE) hospitalizations among children <3 y living in the Quebec Eastern Townships region according to socioeconomic status (SES). Data were gathered from a tertiary hospital database paired with a regional immunization registry. Three cohorts of children were followed: (1) vaccinated children born in post-universal vaccination period (2011–2013, n = 5,033), (2) unvaccinated children born in post-universal vaccination period (n = 1,239), and (3) unvaccinated children born in pre-universal vaccination period (2008–2010, n = 6,436). In each cohort, AGE and RVGE hospitalizations were identified during equivalent follow-up periods to calculate VE globally and according to neighborhood-level SES. Using multivariable logistic regression, adjusted odds ratios (OR) were computed to obtain VE (1-OR). Adjusted VE of 2 doses was 62% (95% confidence interval [CI]: 37%–77%) and 94% (95%CI: 52%–99%) in preventing AGE and RVGE hospitalization, respectively. Stratified analyses according to SES showed that children living in neighborhoods with higher rates of low-income families had significantly lower VE against AGE hospitalizations compared to neighborhoods with lower rates of low-income families (30% vs. 78%, p = 0.027). Our results suggest that the rotavirus vaccine is highly effective in preventing severe gastroenteritis in young children, particularly among the most well-off. SES seems to influence rotavirus VE, even in a high-income country like Canada. Further studies are needed to determine factors related to lower rotavirus VE among socioeconomically disadvantaged groups.

The “Lac-Mégantic tragedy” seen through the lens of the EnRiCH Community Resilience Framework for High-Risk Populations

On July 6th 2013, a train derailment occurred in the small town of Lac-Mégantic, Quebec, Canada, causing a major human and environmental disaster. In this case study, we comprehensively describe and analyze actions taken by the Public Health Department of the Eastern Townships, in close collaboration with community-based organizations, during both the impact phase emergency response and the post-impact recovery operations that continued for months. Due to the complexity of the event, public health actions needed to be broadly diversified. Preventive measures targeted chemical, physical, biological, and psychosocial hazards in the short-, medium- and long-term. Our analyses yielded valuable lessons that will improve and inform our response to future events while serving as a basis for developing a conceptual framework for public health emergency preparedness.